一位55歲男性於手術後返回病房。外科醫師開立了每6小時靜脈注射 60 mg Ketorolac 的醫囑。護理師注意到病患的血清肌酸酐（Creatinine）為 2.8 mg/dL。當護理師提出這個疑慮時，外科醫師大吼：「刀是我開的，別質疑我的醫囑！馬上給藥！」護理師何種處置展現了適當的病患權益倡導與衝突解決？
A 55-year-old male returns from surgery. The surgeon writes an order for IV Ketorolac 60 mg every 6 hours. The nurse notes the patient's serum creatinine is 2.8 mg/dL. When the nurse brings this up, the surgeon shouts, "I did the surgery, so don't question my orders! Administer the medication immediately!" Which action by the nurse demonstrates appropriate patient advocacy and conflict resolution?
- AAdminister the Ketorolac as ordered and document the surgeon's exact response in the nursing notes.遵照指示給予 Ketorolac，並將外科醫師的確切回應記錄於護理紀錄中。
- BInform the patient about the surgeon's behavior and ask the patient to refuse the medication.告知病人外科醫師的行為，並請病人拒絕該藥物。
- CAdminister half the ordered dose to provide some pain relief while protecting the kidneys.給予規定劑量的一半，以在保護腎臟的同時提供部分止痛效果。
- DRefuse to administer the medication and escalate the concern to the nursing supervisor immediately.✓ 正解拒絕給藥並立即向護理主管反映此疑慮。
本題測試當遇到不安全的醫囑與醫療階級衝突時的應對。護理師首先面臨的是病患安全危機：Ketorolac 具有極高腎毒性，在肌酸酐高達 2.8 mg/dL 的病患身上是強烈禁忌。護理師負有不執行潛在致死醫囑的獨立法律責任因此必須拒絕給藥（排除選項A與C）。當直接向開處方的醫師反應卻遭霸凌拒絕時（違反溝通原則），護理師不應與其當面爭吵或將責任推給病患（排除選項B），而應立即啟動機構的呈報機制（Chain of Command），將問題上報給護理主管（Nursing Supervisor），由管理層介入或聯絡其他待命醫師修改處方。這展現了保護病患免於藥物傷害的倡導者角色。
This question tests the response to an unsafe order combined with a hierarchical conflict in the medical setting. The nurse first faces a patient safety crisis: ketorolac is highly nephrotoxic and is strongly contraindicated in a patient whose creatinine is as high as 2.8 mg/dL. The nurse bears an independent legal responsibility not to carry out a potentially fatal order and must refuse to administer the medication (eliminating options A and C). When the prescribing physician is approached directly and the nurse is rebuffed in a bullying manner (violating communication principles), the nurse should not engage in a face-to-face argument with the physician or shift responsibility onto the patient (eliminating option B), but rather should immediately activate the institution's chain of command, escalating the issue to the nursing supervisor, so that management can intervene or another on-call physician can be contacted to revise the prescription. This demonstrates the nurse's role as an advocate who protects the patient from medication-related harm.
台美在面對不合理醫囑時皆強調上報機制。美國極度重視醫護平權與「Safety First」溝通（如 TeamSTEPPS 系統），護士能毫無包袱地上報；台灣臨床因傳統權力位階較深，護理師遇此情況常面臨極大的人際壓力，但為防範法律咎責，現今各大台灣醫院也已建立「跨語系安全通報機制」。